OVERVIEW:  Missouri has no free care law.  The definitions that exist for bad debt and charity care pertain only to a) hospital reporting and b) reimbursements for hospitals that provide a disproportionate share of safety net services and care to the uninsured. 

CITATION:
Health Care Providers, Data Requirements
Missouri Revised Statutes §§ 192.665 to 192.667

Missouri Healthnet Division: Hospital Program
13 Missouri Code of State Regulations 70-15.010

Hospital and Ambulatory Surgical Center Disclosure
19 Missouri Code of State Regulations 10-33.030

TERMINOLOGY:
Charity care

REGULATORY OVERSIGHT:  The Department of Health has oversight authority for hospital reporting of financial data, which includes bad debt and charity care expenses.  Mo. Code Regs. tit. 10, § 33.030. 

DEFINITIONS AND DISTINCTIONS:
For purposes of determining a hospital’s reimbursement through Medicaid Disproportionate Share funds, the following terms apply:

“Bad debt” includes “the costs of caring for patients who have insurance but are not covered for the particular services, procedures or treatment rendered. Bad debts should not include the cost of caring for patients whose insurance covers the given procedures but limits coverage. In addition, bad debts should not include the cost of caring for patients whose insurance covers the procedure although the total payments to the hospital are less than the actual cost of providing care.” Mo. Code Regs. tit. 13, § 70-15.010(2)(B).  

“Charity care” is defined as “result[ing] from a provider’s policy to provide health care services free of charge or a reduction in charges because of the indigence or medical indigence of the patient.”  Mo. Code Regs. tit. 13, § 70-15.010(2)(E).  Charity care must be included and is distinguished from bad debt in the annual financial report hospitals submit to the Department of Health (see Reporting Requirements below).  Mo. Code Regs. tit.19, § 10-33.030, Exhibit D.

FREE CARE AS A COMMUNITY BENEFIT: N/A

ELIGIBILITY REQUIREMENTS: N/A

FINANCING SOURCE:
As part of the regulations governing Missouri’s Medicaid program, there is a provision allowing for hospital reimbursement for the cost of care rendered to uninsured patients, as defined in regulation.  Mo. Code Regs. tit. 13, § 70-15.010(18)(B).  Generally, hospitals are reimbursed 89 percent of the cost of care provided to uninsured patients.  Id.   The cost of the uninsured is determined by multiplying the charges for charity care and allowable bad debts by the hospital's total cost-to-charge ratio for allowable hospital services from the base year cost report's desk review.  Id.  

SERVICES COVERED: N/A

NOTIFICATION REQUIREMENTS: N/A

APPLICATION PROCESS: N/A

GRIEVANCE/APPEAL PROCESS: N/A

REPORTING REQUIREMENTS:
All health care providers shall, at least annually, report financial data to the Department of Health.  Mo. Rev. Stat. § 192.667(1); Mo. Code Regs. tit. 10, § 33.030; see also Mo. Rev. Stat. § 192.665(4) (defining “financial data”).  Charity care is one of the elements that must be included in the financial report and is distinguished from bad debt.  Mo. Code Regs. tit. 10, § 33.030, Exhibit D.  It is not deducted when determining total gross patient revenue.  Id.  The Department of Health shall develop and publish reports pertaining to individual hospitals, which shall be public record.  Mo. Code Regs. tit. 10, § 33.030(2)-(3). 

PENALTIES FOR NONCOMPLIANCE: N/A

OTHER: N/A

U.S. Senate

Kit Bond

274 Russell Senate Office Building
Washington, DC 20510
Tel: (202) 224-5721
Fax: (202) 224-8149
Website: www.bond.senate.gov

Claire McCaskill

717 Hart Senate Office Building
Washington, DC 20510
Tel: (202) 224-6154
Fax: (202) 228-6326
Website: www.mccaskill.senate.gov

U.S. House of Representatives

William Lacy Clay, Jr. - 1st District

2418 Rayburn House Office Building
Washington DC, 20515
Tel: (202) 225-2406
Fax: (202) 226-3717
Website: www.lacyclay.house.gov

Todd Akin - 2nd District

117 Cannon House Office Building
Washington, DC 20515
Tel:  (202) 225-2561
Fax:  (202) 225-2563
Website: www.house.gov/akin

Russ Carnahan - 3rd District

1710 Longworth House Office Building
Washington, DC 20515
Tel: (202) 225-2671
Fax: (202) 225-7452
Website: www.carnahan.house.gov

Ike Skelton - 4th District

2206 Rayburn House Office Building
Washington, DC 20515
Tel: (202) 225-2876
Fax: (202) 225-2695
Website: www.house.gov/skelton

Emanuel Cleaver - 5th District

1027 Longworth House Office Building
Washington, DC 20515
Tel: (202) 225-4535
Fax: (202) 225-4403
Website: www.house.gov/cleaver

Sam Graves - 6th District

1415 Longworth House Office Building
Washington, DC 20515
Tel: (202) 225-7041
Fax: (202) 225-8221
Website: www.house.gov/graves

Roy Blunt - 7th District

2229 Rayburn House Office Building
Washington, DC 20515
Tel: (202) 225-6536
Fax: (202) 225-5604
Website: www.blunt.house.gov

Jo Ann Emerson - 8th District

2440 Rayburn House Office Building
Washington, DC 20515
Tel: (202) 225-4404
Fax: (202) 226-0326
Website: www.house.gov/emerson

Blaine Luetkemeyer - 9th District

1118 Longworth House Office Building
Washington, DC 20515
Tel: (202) 225-2956
Fax: (202) 225-5712
Website: www.luetkemeyer.house.gov

Governor

Jay Nixon

P.O. Box 720
Jefferson City, MO 65102
Tel: (573) 751-3222
Website: www.governor.mo.gov